Breast

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Author:
ronm
ID:
10292
Filename:
Breast
Updated:
2010-03-13 17:43:57
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Assessment
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Description:
Nursing 307
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  1. Breast
    in front (anterior) to the pectoralis major and serratus, between 2nd/6th ribs, extend from sternum to midaxillary line
  2. Tail of Spence
    projects up and laterally into the axilla
  3. Nipple
    rough, round and usually protrudes - wrinkled and indented with tiny milk duct openings
  4. Areola
    surrounds the nipple, 1-2 cm radius
  5. Montogomery’s Glands
    small elevated sebaceous glands. Secrete a protective lipid material during lactation
  6. Glandular Tissue
    • composed of lobules which consist of clusters of
    • alveoli that produce milk
  7. Cooper’s Ligaments
    fibrous bands that attach to chest wall muscles
  8. Central Axillary Lymph Nodes
    high up in the middle of the axilla
  9. Pectoral Lymph Nodes
    along the lateral edge of the pectoralis major muscle, just inside the anterior axillary fold
  10. Subscapular Lymph Nodes
    • along the lateral edge of the scapula, deep in the
    • posterior axillary fold
  11. Lateral Lymph Nodes
    along the humerus, inside the upper arm
  12. Parasternal Lymph Nodes
    at the sternal edges
  13. Infraclavicular Lymph Nodes
    below the supraclavicular
  14. History (Subjective Data)
    • A. Breast pain or tenderness
    • B. Breast lumps, lumps or swelling in axillary area
    • C. Nipple discharge (color, consistency, odor)
    • D. Rash - including axillary and breast
    • E. Breast swelling, change in bra size
    • F. Trauma or injury to breast
    • G. Hx of breast disease, family hx of breast disease (at what age did relative have breast disease and which relative)
    • H. Hx of breast surgery (augmentation, reduction, biopsy, etc.)
    • I. Self Care Behavior - monthly self breast exam, date of last mammogram
  15. Physical Exam/Assessment (Objective Data)
    • A. Inspection of breasts - note symmetry of shape and size
    • 1. Inspect skin texture and color; note any edema, bulging or dimpling
    • 2. Inspect nipple - note symmetry, skin color, texture or lesions (inverted nipples may be a normal variation)
    • B. Screen for retraction - ask pt to lift arms slowly over the head (breast should move symmetrically). Next ask pt to push hands onto her hips then 2 palms together (the pectoralis major should lift slightly)
    • C. Palpation of Axillae - lift pt arm while in sitting position and palpate high into the axillary area
    • D. Palpation of breasts - supine position, pt arm overhead palpate breast tissue using one of two patterns (spokes on a wheel or concentric circles), also include tail of spence in palpation
    • E. Palpate nipple - “milk” your fingers toward the nipple, repeat from different directions, gently squeeze nipple - note any discharge (color and consistency)
  16. If a lump/mass is noted - note these characteristics:
    • A. Location - describe as a clock
    • B. Size - in 3 dimensions (cm)
    • C. Shape
    • D. Consistency
    • E. Movable
    • F. Distinctness - is the lump solitary or multiple
    • G. Nipple - is it displaced or retracted
    • H. Note the skin over the lump - is it erythematous, dimpled or retracted
    • I. Tenderness
    • J. Lymphadenopathy
  17. Dimpling
    cancer
  18. Peau d’Orange
    orange peel look –>cancer (lymphatic obstruction produces edema, exaggerating the hair follicles giving the orange peel look.
  19. Nipple Retraction vs Nipple Inversion
    • recent retraction –> cancer
    • long term nipple inversion –> normal variation
  20. Prominent Venous Pattern
    breast tumor
  21. Fibrocystic Breast Disease or Benign Breast Disease
    • 1. Swelling and tenderness (cyclic discomfort)
    • 2. Mastalgia (severe pain - both cyclic and noncyclic)
    • 3. Nodularity - significant lumpiness (cyclic and noncyclic)
    • 4. Dominant lumps (cysts and fibroadenomas)
    • 5. Nipple discharge (duct ectasia)
    • 6. Infections and inflammations (mastitis, abscess)
  22. Mastitis
    an inflammatory, tender, red, hard mass. Usually an infection or stasis of a plugged duct during breastfeeding.
  23. Gynecomastia
    enlarged breast tissue in males, very common during adolescence and aging males.
  24. Supernumerary Nipple
    an extra nipple along the embryonic “milk line” on the thorax and abdomen is a congenital finding

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